Most of my tomatoes are done for the season but I have two plants that are still producing gorgeous heirlooms.

Most of us gardeners know that letting a tomato ripen on the vine and then picking it just before it is fully ripe gives the best result. I like to let mine ripen on the counter for a day or two. Then the result is delicious home grown flavor and firm flesh.

There is a gardener at my community garden this summer that let his tomatoes stay on the vine until they were overripe. Insects and rodents ate them and some fell to the ground to rot. What a shame! The tomatoes went completely to waste, not to mention the plants didn’t set new blooms for the next round.

Why do I bring this up to you, especially now? Because I’ve been talking to so many doctors lately that tell me they aren’t making changes in their practices because they want to wait and see how Obama-care plays out for the next six months or year. I understand the feeling: none of us knows exactly how things are going to turn out. But I would like to suggest that that makes it exactly the RIGHT time to prepare your practice for change.

Healthcare and changes coming to it are on people’s minds now. More and more people are feeling like they can’t get the relationship they want with their personal physician in a big system or busy clinic. And over the next few months, as more people move into the health care non-system, personal physicians with the time and energy to really care about their patients will be in high demand.

If you’ve been thinking it’s time for a change in your practice, I urge you to consider getting ready for it NOW. Before the idea is overripe.

If you have any inclination that the time is getting close for you to make a change, consider spending a few hours focusing just on your practice with me. I think you’re worth it. Click below for an easy way to start to move toward your goal.

Physicians are being pulled in many directions. Now over 50% of physicians report at least one symptom of burnout. Feeling responsible for things out of your control, not enough time to get everything done with deadlines by the end of the day, wanting to return phone messages but also wanting to be home before the baby’s bedtime, a desire to carefully review all the old records received pitted against enough time to take a long walk in the fresh air during lunch break, wanting to spend more time with the patient you are in the room with now, but knowing that doing so will make you late for the rest of the patients scheduled this morning. These dilemmas become so much a part of our days that we cannot imagine “work” without them.
There are many reasons that our health care system is not getting the outcomes that are theoretically possible from a perfect system: a procedural/cognitive payment ratio that favors doing more over thoughtful communication, insurance requirements that pit the doctor against the patient by requiring prior authorizations and limits on referrals to specialists, and a structure that promotes short, frequent visits rather than appropriate communication by phone, email, and longer in person visits. All of these working conditions for doctors add to the stresses that we anticipated when we chose to enter the field of medicine, which in and of themselves, are substantial. These include being with people in the times of their lives with the greatest stress: serious illness, disability, and death; discerning how to communicate bad news to people and help them sort through very complicated decisions about treatment options; and advising patients on ways to maintain health in environments that challenge.
Since entering medical school over 25 years ago, I have lived with these stressors and observed what they can do to my colleagues and friends. I was blessed enough to have role models who worked part-time and kept relationships with families and friends at the forefront of their lives. I also chose a specialty, Family Medicine, that believes in looking at the person in the context of family and society. By studying health care ethics, medical anthropology, and medical economics before entering the profession, I entered somewhat more hesitantly than many, with my eyes open to some of the flaws and challenges that we as a profession face.
I believe we are at a critical time for medicine in the United States right now. Systems are changing faster than outcomes can be predicted. No one really expects a small private practice to exist in the same way it does today twenty or thirty years from now. Do we encourage our kids to study medicine? Do we try to figure out how early we can afford to retire? Are we able to stand tall with the decisions we make in how we care for our patients? There is much advocacy in medicine that needs to happen. We need fellow doctors that will stand up and represent us in our professional societies, to businesses, to Congress, and to patient groups. But I believe we also need someone to stand up for the doctors. And that is what I try to do in MD Mentors. Physicians are extremely talented professionals that have been tested in the fires of residency and have learned to deal with many different stressors over the years. We are in charge of so many things and people, we get our required CME units, keep our licenses and Board certifications up to date, get our CLIA certificate or our waiver-of-CLIA-certificate certificate. Sometimes we are raising our kids at the same time we are dealing with our parents’ aging and health problems. Some of us have our own serious health problems. Is it no wonder that we don’t take time to process the emotional and spiritual impact of it all on ourselves? While we may sometimes feel we don’t really need support from our peers, I would argue that it is one of the most important gifts we can give ourselves, our patients, and our health care system: time with other physicians to develop our resilience and support system. While researching how this could be possible, I discovered that the AMA, CMA, and BMA co-sponsor a conference on physician well being every other year. In 2012, some researchers from the Mayo Clinics presented some interesting findings: 90 minutes every other week over 9 months in a structured, facilitated small group with other physicians led to greater job satisfaction and happiness than the equivalent 90 minutes “off”? This is an exciting finding for someone like me, who prides herself on being “evidence based.” Since learning of this study, I have developed a similar program for doctors in small practices, who may not have the resources of a large institution, but who want to thrive as physicians in our health care system. If you are a physician who is basically emotionally and spiritually healthy, and who wants to grow a support network and develop greater resilience, an MD Mentors Village may be what you are looking for. Stay tuned.

The article linked above talks about Dr. Ravin Talati in Duluth who runs a membership practice ($35/month and $15/visit). He has 45 minute appointments and no longer spends 2 1/2 hours a day doing paperwork. Do you have time to develop healing relationships with your patients? Do you have time to be with your family, to exercise, to keep friendships, to be active in your community, to stay healthy yourself?

Do you feel like you are always working? Laptops with EMR access from anywhere and smart-phones that enable you to work from the soccer field or family room can be life-savers for those of us trying to combine a busy practice with an active life. But some days I long for the paper chart days of group medicine when I we weren’t allowed to remove the charts from the building. We had to stay later, but when we were out of the office, we were finished with our charts. Now, you can do them anywhere and anytime.

I found this article by Peter Bregman interesting. He shares some stories from his life as a CEO that might be relevant to your life as a doctor.

Consider learning to put back up some of the walls that separate your practice from the rest of your life, so you have some time to really live.

Making sure you have time and space to live away from the “being a doctor” part of your life may end up improving not only your life with your family and friends, but also your doctoring too.

The North Star (in the case of the earth, Polaris), is the point of reference that can be used to navigate from anywhere in the Northern Hemisphere (and a bit of the Southern Hemisphere). This is because it is aligned with the axis of the earth. I love using the analogy of the North Star for what is aligned with our true selves. Think of the North Star as the vision of your practice that is really aligned with you: the practice you would love and the patients you would enjoy taking care of. It is fun to be a doctor when your patients are those that are the right fit, so that the relationship benefits both the patient and the doctor.

Doctors who follow their North Star may find themselves changing the way they practice. Some may tweak the attitude they bring to the work and this may make all the difference. Others may want to make bigger changes: longer appointments, a new arrangement of the exam room, a day off. Some will decide it is time to completely revamp the way they think about and structure their practice: quit a salaried job and start a solo practice, become a hospitalist, drop insurance and convert to direct pay by the patients, start a house call practice, move to a new part of the country or the world. The MD Mentor’s purpose is to help you discover your North Star and be a guide to help you find a way there. Working with The MD Mentor is unpredictable, exciting, and fun. If you want to remember your dream for medicine, and figure out how to bring it into being, this may be your place.